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Managing atrial fibrillation in primary care

Atrial fibrillation is the most common sustained adult cardiac arrhythmia. Our work has shown how healthcare professionals, managers and commissioners can contribute to best practice in care. 

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Around 1.3 million people in the UK have been diagnosed with atrial fibrillation (AF), with many thousands more thought to be living with the condition undiagnosed.1

Our pilot programme of placing arrhythmia care co-ordinators (ACCs) on site has enhanced detection and effective management of cardiac arrhythmia.

The challenge with AF

AF raises the risk of stroke by up to five times, as well as increasing the risk of heart failure, vascular dementia, hospitalisation and death. One in five strokes are linked to AF.2

AF-related strokes are more likely to be fatal or cause severe disability than non-AF-related strokes.3

The most common symptoms are palpitations, breathlessness, dizziness and syncope. However, with many people with AF not showing any symptoms, many people will not realise they require treatment, or that they may be living with a greatly elevated risk of stroke.

Care in the UK can be sub-optimal and patients have reported poor explanations of their condition and treatment options.

The call for change in AF management

AF-related strokes are debilitating. Those affected are less likely to get back to independent living and many are less likely to survive. UK audits suggest anticoagulation to reduce the risk of AF-related stroke is under-utilised.

The management of AF in primary care across the UK presents a resource challenge, mainly through referrals and hospital admissions. The challenge is likely to grow as our population ages. However, it is possible to identify potential efficiencies if strategies to address these issues are incorporated into planning and policy development.

The importance of integrated care

AF is a long-term condition. Providing integrated care can help to ensure that patient pathways are seamless, safe and person-centred.

We funded an Integrated Care pilot programme at nine NHS organisations across the UK. The aim was to improve service provision for people living with cardiovascular disease (CVD) by integrating primary and secondary care through developing several models of care.

Two of the nine projects incorporated AF management among the new models of care. Both funded two 0.5 whole-time equivalent specialist nurses for two years.

NHS Tayside project

At the NHS Tayside pilot site, there were three strands around arrhythmia care; one included establishing rapid-access AF clinics across the health board. This project has been implemented successfully, operating at full capacity and is now sustained by the local health board.

NHS Lanarkshire project

At NHS Lanarkshire, the project involved audit and education for primary care clinicians as well as education for secondary care specialist nurses. After one year, this showed an increase in the prescribing of anticoagulants and an expected reduction of 70 AF-related strokes – a reduction of 14% from baseline.

You can learn more about the Lanarkshire project in our publication, Management of AF in Primary Care – the NHS Lanarkshire experience.

The Tayside project is referenced in our programme summary document, Integrated Care Best Practice.

You can also read an independent evaluation of the Integrated Care programme [PDF], including these two projects.

Resources and further information

Arrhythmia Care Coordinators

Our Arrhythmia Care Coordinators programme provides evidence for how this professional role can help improve quality of care for the two million people with arrhythmias or heart rhythm problems in the UK.

Business case toolkit

Interested in setting up your own integrated care AF service? Our free online Business Case Toolkit resource, could help you make your case.

Contact us

To speak to us about how you could help to integrate services in your area, contact us today.

References

1  Quality and Outcomes Framework data 2017/18. (NHS Digital/ISD Scotland/StatsWales/DHNI)
2  Public Health England (2018) AF: How can we do better guide
3  Marini C, De Santis F, Sacco S et al. (2005) Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 2005;36:1115-19

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